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Eghbal K, Zafarshamspour S, Sookhaklari M, Saffarian A, Taheri R. Clinical Outcome of Pedicle-Sparing Transfacet Diskectomy and Fusion with Segmental Instrumentation for Thoracic Disc Herniation. J Neurol Surg A Cent Eur Neurosurg 2024; 85:240-245. [PMID: 36584877 DOI: 10.1055/a-2005-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive surgery than anterior and lateral approaches. A pedicle-sparing transfacet approach was initially described in 1995, and modified in 2010. A few clinical series have reported the outcome of this procedure in patients with TDH. This study aimed to evaluate the outcomes and complications of pedicle-sparing transfacet diskectomy with interbody fusion and segmental instrumentation in patients with TDH. METHODS Twenty-one consecutive patients with symptomatic TDH referred to our tertiary care center were included in this retrospective study. All patients underwent a pedicle-sparing transfacet diskectomy with polyetheretherketone (PEEK) cage interbody fusion and short segmental instrumentation. Distribution of TDH, operative duration, blood loss, Visual Analog Scale (VAS) pain scores, Nurick grades, modified Japanese Orthopaedic Association (mJOA) scores, and fusion rate were assessed. RESULTS All patients had single-level herniations. The most common location was T12-L1 (38.1%), followed by T11-T12 (33.3%). All patients were successfully operated on with no cerebrospinal fluid (CSF) leaks or wrong-level surgery. The VAS scores significantly diminished from 4.9 (preoperatively) to 2 (18 months after surgery). The average mJOA score increased from 4.6 to 8.5, and the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in quality of life relative to their preoperative status. CONCLUSION A modified pedicle-sparing transfacet diskectomy combined with PEEK cage interbody fusion and segmental instrumentation offers a safe and less invasive approach for the treatment of TDHs.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Zafarshamspour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Surgery, Rafsanjan University of Medical Sciences, Kerman, Iran
| | | | - Arash Saffarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Taheri
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Zafarshamspour S, Lesha E, Cecia A, George H, Ghasemi-Rad M, Trinh K, Yaghoobpoor S, Ghorani H, Majd ME, Eghbal K. Traumatic atlantoaxial rotatory fixation in adults: a systematic review of published cases. Neurosurg Rev 2024; 47:90. [PMID: 38376669 DOI: 10.1007/s10143-024-02315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Atlantoaxial rotatory fixation (AARF) in adults is a rare and clinically challenging condition characterized by a spectrum of etiological factors, predominantly attributed to traumatic and inflammatory pathologies within the craniovertebral region. Trauma is the most frequently identified cause within the adult population, with the first case report published in 1907. This study aims to conduct a systematic review that addresses the clinical presentations and management strategies relating to traumatic atlantoaxial rotatory fixation in adults. A comprehensive search of the PubMed database was executed, adhering to the PRISMA guidelines. The inclusion criteria encompassed case reports and series documenting AARF cases in individuals aged 18 and above, spanning database inception to July 2022. Studies not published in the English language were excluded. A total of 61 articles reporting cases of AARF in the adult population were included in the study. The mean age of affected individuals was 36.1 years (± 15.6), with a distribution of 46% females and 54% males. Predominant mechanisms of injury included motor vehicle accidents and falls, constituting 38% and 22% of cases, respectively. Among the classification systems employed, Fielding and Hawkins type I accounted for the majority at 63%, followed by type II at 10%, and type III at 4%. Conservative management was used for treatment in 65% of acute (65%) cases and 29% of chronic cases. Traumatic AARF is a rare phenomenon in the adult population, is more common in younger adults, and does not often present with neurologic deficits. Patients diagnosed acutely are more likely to be successfully treated with conservative management, while patients diagnosed chronically are less likely to be reduced with conservatively and often require surgical treatment. Surgery should be considered for patients with irreducible dislocations, ligamentous injuries, unstable associated fractures, and persistent pain resistant to conservative management.
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Affiliation(s)
- Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran.
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Emal Lesha
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Arba Cecia
- School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Haydy George
- School of Medicine, St. George's University, West Indies, Grenada
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Trinh
- Texas Tech University Health Sciences Center School of Medicine, Houston, TX, USA
| | - Shirin Yaghoobpoor
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
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Hosseini EM, Zafarshamspour S, Ghasemi-Rad M, Benndorf G, Rasekhi A, Rafieossadat R. Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature. Childs Nerv Syst 2024; 40:345-357. [PMID: 37750891 DOI: 10.1007/s00381-023-06161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) constitute a notable portion of pediatric intracranial aneurysms. Their unstable structure dictates a high incidence of rupture or mass effect from enlarging unruptured aneurysms, necessitating prompt diagnosis and treatment. TICAs often lack a true neck or are wide-necked, making them unsuitable for coil embolization and surgical clipping, and their fragile nature poses a risk of rupture during surgical and intrasaccular interventions. Endoluminal flow diverters (FD), deployed without requiring direct access to the aneurysmal sac, have emerged as an appealing sole treatment modality for TICAs. However, the clinical experience with this technique remains limited in the pediatric population. METHOD We describe the successful treatment of a paraclinoid TICA in a 4-year-old female using an endoluminal FD alone. Additionally, we conducted a literature review to assess the safety and effectiveness of this treatment modality in pediatric TICAs. RESULTS Endoluminal flow diversion led to complete aneurysm obliteration in our case, with no observed complication, at the 9-month follow-up. Our review of the previously reported pediatric TICAs managed by standalone flow diversion highlights this technique as safe, efficient, and promising as a sole treatment modality, particularly in the anterior circulation, with a high rate of persistent total obliteration and a low rate of complications. However, the requirement for long-term antiplatelet therapy with the possibility of frequent dose monitoring and adjustments warrants special attention when using endoluminal FDs. Until guidelines specifically addressing optimal antiplatelet therapy in children with intracranial FDs are formulated, adherence to existing protocols is imperative to avoid in-stent thrombosis. CONCLUSION Our literature review and personal experience indicate that endoluminal flow diversion can be a viable treatment approach for pediatric TICAs. However, prospective studies with extensive follow-ups are required to assess the durability of endoluminal FDs in treating pediatric TICAs, considering the long life expectancy of this demographic.
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Affiliation(s)
| | - Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Goetz Benndorf
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rafieossadat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Mohammad Hosseini E, Sepehrvand N, Ghasemi-rad M, Shastri R, Jamali M, Rahmanian A, Habibzadeh A, Taheri R, Zafarshamspour S. Duplication and aneurysm of the anterior communicating artery with triplication of the anterior cerebral artery: A rare case-report. Interdisciplinary Neurosurgery 2023. [DOI: 10.1016/j.inat.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Eghbal K, Zafarshamspour S, Tamjidi M, Khosravifarsani A, Jaloliddin Begijonovich M, Tayebi Khorami S. Surgical Management of Adult Traumatic Atlantoaxial Rotatory Fixation with Hangman Fracture: Case Report and Literature Review. Arch Bone Jt Surg 2023; 11:301-305. [PMID: 37180294 PMCID: PMC10167529 DOI: 10.22038/abjs.2022.68949.3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 05/16/2023]
Abstract
Atlantoaxial rotatory fixation (AARF) is a rare type of adult cervical spine injury. The classic symptoms are painful torticollis and limited neck range of motion. To avoid catastrophic consequences, early diagnosis is necessary. The present study presents the successful treatment of a scarce case of adult AARF with a Hangman fracture and a comprehensive literature review. A 25-year-old man presented to the trauma bay with left-sided torticollis after a motor vehicle accident. Cervical computed tomography scans revealed type I AARF. Torticollis resolved after cervical traction with partial reduction, and posterior C1-C2 fusion was performed as part of the therapy. Recognition of AARF after trauma requires a high index of suspicion, and early diagnosis is critical for the achievement of the best possible patient outcomes. Since the combination of a Hangman fracture and C1-C2 rotatory fixation is complex and unique, it must be tailored to the associated injuries.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Eghbal K, Oveisee M, Safaee J, Zafarshamspour S, Saffarrian A, Rakhsha A. Traumatic Cervical Vertical Translational Injury: A Case Report. Bull Emerg Trauma 2022; 10:135-137. [PMID: 35991370 PMCID: PMC9373057 DOI: 10.30476/beat.2021.89226.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/23/2021] [Accepted: 06/26/2021] [Indexed: 11/19/2022] Open
Abstract
Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining of cervical pain, with a GCS score of 15/15. His neurological examination was unremarkable. The cervical CT scan revealed a vertical translation at the C6-C7 level (roughly 11 mm) and bilateral facet joint diastases which are highly unstable injuries. A two-stage combined anterior and posterior fixation operation was performed. First, an anterior cervical discectomy and fusion with autologous graft and plate fixation, and then a posterior approach with lateral mass screw fixation was performed. Disruption of the anterior longitudinal ligament, annulus fibrosis, facet capsules, and severe strain of ligamentum flavum was noted intraoperatively. He had no early and late complications within 2 years of follow-up.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maziar Oveisee
- Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Safaee
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Zafarshamspour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Saber Zafarshamspour, Address: Department of Neurosurgery, Nemazee Hospital, Shiraz University of Medical Sciences, Nemazee Square, 7193711351, Shiraz, Iran. Cellphone: +98-914-1467267; Fax: +98-71-36474259, e-mail:
| | - Arash Saffarrian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rakhsha
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Sedighimehr N, Zafarshamspour S, Sadeghi M. Effects of dry needling on muscle spasticity of the upper limb in a survivor of traumatic brain injury: a case report. J Med Case Rep 2022; 16:237. [PMID: 35701822 PMCID: PMC9195242 DOI: 10.1186/s13256-022-03408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Survivors of moderate and severe traumatic brain injury typically present with spasticity, an upper motor neuron lesion associated with hyperexcitability of the stretch reflex due to disinhibition of cortical influences on spinal cord circuits and structural and functional changes in skeletal muscle. There is growing evidence supporting the effectiveness of dry needling in abating spasticity. Case presentation The present case aims to quantify the effects of dry needling on upper limb spastic muscles in a survivor of severe traumatic brain injury in a 27-year-old Iranian man. The treated muscles were biceps brachii, brachialis, flexor digitorum superficialis and profundus, flexor carpi radialis, flexor carpi ulnaris, opponens pollicis, and adductor pollicis. Outcome measures were evaluated before and 1 hour after the intervention. Our results showed that the patient’s upper limb recovery stage and hand function improved one grade according to Brunnstrom recovery stages. Spasticity assessed using the Modified Modified Ashworth Scale in all movements showed one-grade abatement, except in the forearm pronator. Passive resistance force decreased in all movements except in forearm supination. Active range of motion and passive range of motion increased in all movements except in active and passive forearm supination. Hand dexterity improved in both affected and unaffected hands. Conclusions Results shown that dry needling could be a favorable option for reducing spasticity.
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Affiliation(s)
- Najmeh Sedighimehr
- Physiotherapy Department, School of Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran. .,Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Saber Zafarshamspour
- Consultant Neurosurgeon, Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran
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Masoudi MS, Zafarshamspour S, Ghasemi-Rad M, Soleimani N, Lincoln C. Intracranial Rhabdomyosarcoma of the Cerebellopontine Angle in a 6-year-old Child: A Case Report. J Pediatr Neurosci 2020; 15:124-127. [PMID: 33042245 PMCID: PMC7519750 DOI: 10.4103/jpn.jpn_70_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft-tissue malignancy in children under 15 years of age. Approximately, 35% of RMS cases originate from the head and neck region. Among various sites in the head and neck region, intracranial extension is more likely to occur with parameningeal tumors, which is also considered an unfavorable prognostic factor in children with RMS. About 20% of RMS occurs in a parameningeal site. Intracranial RMS are rare tumors that usually arise from parameningeal sites or metastasis from an extracranial site. Primary intracranial types are even rarer, with only 50 reported cases of primary intracranial RMS in the literature. Hereby, we report the case of a 6-year-old boy who presented with clinical and radiologic features of a cerebellopontine angle lesion, which turned out to be a RMS.
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Affiliation(s)
- Mohammad Sadegh Masoudi
- Department of Neurosurgery, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Zafarshamspour
- Department of Neurosurgery, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Neda Soleimani
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christie Lincoln
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Sadegh Masoudi M, Zafarshamspour S, Ghasemi-Rad M, Soleimani N, Rakhsha A, Lincoln C. Acute Subdural Hemorrhage of a Convexity Meningioma in the Postpartum Period; Case Report and Literature Review. Bull Emerg Trauma 2019; 7:324-329. [PMID: 31392235 DOI: 10.29252/beat-0703018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
New onset seizures in pregnancy or the postpartum period can be of great importance and denote various underlying pathologies. Eclampsia and cerebrovascular accidents are common, and brain tumors are uncommon causes of postpartum seizures among others. Acute presentation of brain tumors in pregnancy or the postpartum period is extremely rare. Meningiomas are the most common benign intracranial tumors. Although 1.3 to 2.4% of these benign tumors may bleed, acute presentation of them with hemorrhage is quite rare. Herein, we report a rare case of a 36-year-old lady who presented with severe headache, seizure, and loss of consciousness in the postpartum period, five days after delivery of a full-term baby. Primary emergency evaluation revealed an extra-axial lesion with subdural hemorrhage. A Decompressive craniectomy was performed, hematoma was evacuated, and the tumor was totally resected. Histopathologic evaluation was consistent with a fibroblastic meningioma (WHO grade I). She was discharged in good general condition. Our case highlights the significance of complete evaluation of patients with new-onset seizures in pregnancy or the postpartum period. Although uncommon, brain tumors in pregnancy can have potentially devastating outcomes which may necessitate prompt surgical intervention.
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Affiliation(s)
- Mohammad Sadegh Masoudi
- Departmet of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.,Neurotrauma Research Center, AJA University of Medical Sciences, Tehran, Iran
| | | | | | - Neda Soleimani
- Departmemt of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rakhsha
- Departmet of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christie Lincoln
- Department of Radiology, Baylor college of medicine, Houston, Texas, USA
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Salehiniya H, Hassanipour S, Namvar G, Fathalipour M, Ghorbani M, Abdzadeh E, Zafarshamspour S, Riahi S, Mohammadian-Hafshejani A. The incidence of brain tumours in Iran: A systematic review and meta-analysis. Adv Hum Biol 2019. [DOI: 10.4103/aihb.aihb_60_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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